MEDICARE: MARCUS JAY WILSEY CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	AP60404040	WA
2	367500000X	Certified Registered Nurse Anesthetist	60417368	WA
3	367500000X	Certified Registered Nurse Anesthetist	100143	MT

General Provider Information

NPI Number	:	1316374820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS JAY WILSEY CRNA

Provider Business Mailing Address
First Line	:	PO BOX 190371
Second Line	:
City	:	HUNGRY HORSE
State	:	MT
Zip	:	59919-0371
Country	:	US
Telephone Number	:	406-249-8451
Fax Number	:

Provider Business Practice Location Address
First Line	:	9589 HIGHWAY 2 EAST
Second Line	:
City	:	MARTIN CITY
State	:	MT
Zip	:	59926
Country	:	US
Telephone Number	:	406-249-8451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2013
Last Update Date	:	11/27/2023

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